HAZARDS OF ANAESTHESIA

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HAZARDS OF ANAESTHESIA

• G.K.KUMAR

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DEFENITON

• DANGER/RISK
• ANESTHESIOLOGISTS
• PATIENTS

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HAZARDS FOR ANASTHESIOLOGISTS

• Fire explosions
• Electrical accidents
• Pollutions by anesthetic agents
• Radiations
• Infections
• Incompatibilities / allergies
• Stress
• Chemical dependence

OR
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HAZARDS FOR ANASTHESIOLOGISTS

• PHYSICAL
• -ELECTRICAL
• -ENVIRONMENTAL
• -INFECTIVE
• -ALLERGY
• PSYCOLOGICAL
• -STRESS
• -DEPENDENCY

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Electrical accidents

• Unsafe electrical configurations
• Types-macro shock
• -micro shock
• -loss of power supply to gadgets
• Safe practices

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Electrical accidents

• Macro shock
• -Large voltage current
• -Causes tissue damages
• burns
• explosions

1ma perception
5ma harmless
10-20ma Muscular contraction
50-100ma Pain, fainting
100-2500ma VF
gt6000ma Resp.arrest
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Electrical accidents

• Micro shock-Direct application of very small
  voltages to the heart thro electrodes
• Allowable leakage thro electrodes-10µA
• gt50µA-VF occurs

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Electrical accidents
- Safe practices

1. Proper grounded equipments(3pin)
2. Dont connect the pt to the OR grounding sources
3. Electro cautery large grounding pads, to be kept
   well away from electrodes PM
4. Use bipolar
5. Reset the pace maker to regular
   mode(asynchronised)
6. Keep ready pharmacological pacing- Isoprenaline
7. Good maintenance of equipments

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Pollution by anesthetic agents

• Risks
• Recommendations
• Remedies

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Pollution by anesthetic agents

• Risks- Real? Or Mystiques?
• -abortions
• -congenital abnormalities
• -malignancies (liver)
• -behavioral problems(N2O)

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Pollution by anesthetic agents

• Recommendations
• Upper limits

N2O 25ppm
Halogenated agents 2ppm
Halogenated agents with N2O 0.5ppm
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Pollution by anesthetic agents

• Remedies
• Scavenging systems
• Closed circuits
• Anti spill devices
• Avoid agents

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Radiation hazards

• Risks
• Recommendations
• Remedies

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Radiation hazards

• Risks
• Ionizing radiation-Xray, radioactive isotopes
• Formation of free radicals, ionizing molecules
• Damage/destruction of cells,
  Ch anomalies, malignancies.

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Radiation hazards

• Risks
• Non-Ionizing radiation laser
• Disruption of electrons from one orbit to others,
  but with in cells
• Tissue damage
• Laser plums formation (contain viable
  bacteria,HPV DNA,HIVproviral DNA)

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Radiation hazards

• Recommendations
• Max. allowable exposure/yrlt5Rem
• during pregnancy-500mRem
• 0ne Xray-25 mRem
• Natural exposure cosmic rays-40mRem

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Radiation hazards

• Remedies for ionizing radiation
• Scattered rays inv. Proportional to (distance)2
  from the source
• Best way of protection-physical separation
• (6 ft 9 in concrete 2.5 mm lead)
• Protective lead aprons (o.25-o.5mm)

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Radiation hazards

• Remedies for non-ionizing radiation
• Radiation intensity not decreased to distance in
  an average OR.
• Proper gaggles
• Laser plum to be removed by effective scavenging
  systems removes particles o.1µm (filters
  0.5µm).

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Infections

• Physical spread-HSV,CMV
• Blood borne-HIV,HBV,HCV
• Air borne-Mtb

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Infections

• Blood borne diseases thro Needle stick injuries-
  HIV0.3, HBV3, HCV30
• 32 had at least 1 NSI in the preceding
  12M.(only half of them took treatment).
• More risk with hollow-core large bore
• NSI more in non dominated hands
• NSI more during disposal of contaminated needles.
• Anesthesiologists have risk for occupational
  infection during 30years of exposure-0.045-4.5

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Infections-HIV

• Health care workers contribute 5 of total cases
• 4 of emergency department pts are unidentified
  cases.
• Pts considered infective if both screening
  (ELISHA) confirmatory (western blot, indirect
  fluorescent ab) tests are positive.

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Infections-HIV

• 54 reported cases of occupationally acquired
  HIV(1998).
• 88 of them had H/O NSI
• ? Quantity of inoculums- ( a case report
  100-200µml of blood throi.v. produced HIV).
• Risk for the pts- 6 cases reported.

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Infections-HBV

• Non immunized health care workers higher risks
• 17.8 0f seropositive among anesthesiologist
• 30 became positive after 11 years of exposure
• Disinfectants gloves are not completely
  protective- viruses viable for gt14 days in
  needles, gloves, surfaces.

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Infections-HCV

• No immunization available
• No specific treatment available
• Advice serologic monitoring for HCV LFT 3-6
  monthly.

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Infections

• Management of occupational infections.
• SAFE PRACTICE
• Protective equipments
• Washing methods
• Disposal methods

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Infections
-CDC recommendations

• Universal precautions-1980
• -considering as all pts, blood body fluids
  are infective.
• Isolation precautions-1996
• -2 tier recommendations
• Standard precautions -to be followed for handling
  all pts as UP.
• Transmission based precautions -for handling pts
  known to be / suspected of being risks.

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Infections
-CDC recommendations

• Transmission based precautions
• Based on specific the properties of specific
  pathogens
• Airborne precautions measles,varicella,Tb -to
  prevent from small particleslt5µm by specific
  filters air handling devices.-HEPA, Negative pr
  environment
• Droplet precautions HI-type b, mycoplasma,
  streptococcal pharyngitis, rubella-to prevent
  from large particlesgt5µm, keep distancegt1m
• Contact precautions HAV, HSV, viral
  conjunctivitis

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Incompatibilities / Allergies

• Latex allergy
• Type iv/ type I
• Risk groups
• Atopics,
• Spina bifida,
• Urogenital abnormalities ,
• HCW,
• Rubber factory workers.

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Latex allergy

• Managements
• Identification of risk groups
• Use latex free objects-latex free environment
• TestsRASTradio-allergo-sorbent test
• SPT
• Sr.histamine
• Urinary histamine
• Sr.IgE
• Sr.compliments
• Sr.tryptase

Screening tests
Tests for anaphylaxis
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Latex allergy

• Managements-drug regimens
• Preoperative protocol
• Dipenhydramine -1mg/kg,po/iv,q 6hr at 13,7,1hr
  before surgery
• Prednisolone -1mg/kg,po/iv,q 6hr at 13,7,1hr
  before surgery or hydro cortisone 4g/kg
• Ranitidine - 2mg/kg po, 1mg/kg iv,q 12hr at
  13,1hr before surgery
• Postop protocol
• -drugs to be repeated for 12hrs

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Stress

• Inevitable, universal phenomenon to which no one
  is immune
• Job related stress are unavoidable but may be
  controlled
• 2 types-Unavoidable Avoidable
• Unavoidable-professional stress
• Avoidable-sleep related

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Stress

• Unavoidable Stress
• Professional Stress
• Co-worker relationships
• Work load
• Litigations
• Peer review
• Professional dissatisfaction
• Administrative responsibilities

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Stress

• Avoidable Stress
• Sleep related-altered sleep pattern, sleep
  deprivation
• Coincide with natural sleep peaks2-7a.m
• Identification of sleep disturbances
• Regulations of working hours

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Chemical dependence

• Self administration of drugs suicide rates are
  high among anesthesiologist.
• Addiction compulsive continued use of drugs in
  spite of adverse, a chronic, relapsing condition
  resulting from long term effects of drugs on
  brain, due to molecular, structural, cellular,
  functional changes.
• Dependence physical / psychological inability to
  control drug use
• Abuse use of drugs in detrimental way but not to
  the point of addiction. a pre addiction level,
  can easily quit. a voluntary act.

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Chemical dependence

• Causes
• Stress
• Availabilities
• Curiosity for experimentation
• Drug potency
• Others-genetic predisposition

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Chemical dependence

• Management
• Identification
• Intervention
• Referral
• Rehabilitation